Butterfly vertebra and block vertebra are usually reported incidental radiological view, which is a rare congenital defect of spine. Butterfly vertebra is a body formation characterized by anterior and median aplasia. The block vertebra is the result of an embryonically incomplete separation of vertebral bodies or arches or both. This rare congenital anomalies butterfly and block vertebra are usually stable and do not cause clinical symptoms.

Introduction: The novel corona virus (COVID-19) is considered to spread from person to person. There is no clear evidence that animals play a role in the spread of COVID-19. Objectives: The subject of this study was the correlation between pet contact and COVID-19 pneumonia. Patients and Methods: The participants were questioned by creating contact categories of indoor, garden, street and workplace as contact environments with pets. Results: No statistically significant correlation was found when the COVID-19 patients who came into contact with pets in the home were compared whether they had COVID-19 pneumonia or not. Discussion: Despite the fact that the probability of spread to humans from cats and dogs is low, COVID-19 can be spread to cats and dogs. In this study, it was detected that while those who came into contact with dogs were not different from those who were in contact with dogs, they had more lung involvement than those who had outdoor contact, which suggests that various mechanisms may play a role in virus spread.

Objectives: Coronavirus disease (COVID-19) is a disease with high mortality due to acute respiratory distress syndrome (ARDS) secondary to viral pneumonia. In addition to its effects on the respiratory system, coronavirus is known to have serious systemic effects on the cardiovascular system. In this study, we aimed to investigate the association between prolonged QTc duration and COVID-19 specific pulmonary involvement Methods: Between December 2020 and February 2021, 112 patients who were diagnosed with COVID-19 in our COVID-19 outpatient clinic and met the inclusion criteria were evaluated for the association between cardiac variables (heart rate, PR width, QRS width, fQRS, and QTc interval), other patient characteristics and lung involvement. Results: A significant difference was found between the QTc intervals of COVID-19 patients with and without lung involvement (p < 0.026). In the ROC analysis for the QTc interval, which was found to be significant in the multivariate regression analysis, the cut-off value of 419.5 ms had a sensitivity of 72% and a specificity of 51.6% in predicting pulmonary involvement. Conclusions: Prolonged QTc duration may be useful in predicting COVID-19 pulmonary involvement in patients admitted to the emergency department.

In traditional medicine garlic is used intensely for it’s antimicrobial, antihypertensive and anti hyperlipidemic etc. effects. For this reasons, use of garlic is common among the public health. In this case we aimed to present a patient with a second degree skin burn because of self applying garlic on his superficial eruptions.

Aim: Metabolic acidosis is the most serious complication of methanol intoxication, which needs urgent treatment. The aim of this study was to investigate effects of "Trometamol; Tris-hydroxymethylaminomethane" (THAM) and "Sodium Bicarbonate" (NaHCO3) treatments on mortality and survival time in rats with metabolic acidosis induced by intragastric-administered methanol. Materials and Methods: In 21 rats, a cannula was inserted in the right common carotid artery; the esophagus of each rat was penetrated with a branul. Baseline arterial blood gas samples were taken, and a 6 g/kg dose of methanol was injected into the cannula in the esophagus. The rats with confirmed acidosis were separated into three groups as "THAM," "NaHCO3," and "control" for the treatments. The control group received no medication, and the THAM and NaHCO3 groups were administered corresponding treatments intravenously. Results: A statistically significant difference was determined between the survival times of the THAM and NaHCO3 groups (p=0.036) and the THAM and control groups (p=0.002). Conclusion: The results of this study support the use of THAM, which is a biological, low-toxicity, inert amino alcohol, instead of NaHCO3 in the treatment of metabolic acidosis induced by intragastric methanol intoxication.

Fibrillin-1 is a major component of the extracellular microfibrils, where it interacts with other extracellular matrix proteins to provide elasticity to connective tissues, and regulates the bioavailability of TGFβ family members. A peptide consisting of the C-terminal 140 amino acids of fibrillin-1 has recently been identified as a glucogenic hormone, secreted from adipose tissue during fasting and targeting the liver to release glucose. This fragment, called asprosin, also signals in the hypothalamus to stimulate appetite. Asprosin levels are correlated with many of the pathologies indicative of metabolic syndrome, including insulin resistance and obesity. Previous studies and reviews have addressed the therapeutic potential of asprosin as a target in obesity, diabetes and related conditions without considering mechanisms underlying the relationship between generation of asprosin and expression of the much larger fibrillin-1 protein. Profibrillin-1 undergoes obligatory cleavage at the cell surface as part of its assembly into microfibrils, producing the asprosin peptide as well as mature fibrillin-1. Patterns of FBN1 mRNA expression are inconsistent with the necessity for regulated release of asprosin. The asprosin peptide may be protected from degradation in adipose tissue. We present evidence for an alternative possibility, that asprosin mRNA is generated independently from an internal promoter within the 3′ end of the FBN1 gene, which would allow for regulation independent of fibrillin-synthesis and is more economical of cellular resources. The discovery of asprosin opened exciting possibilities for treatment of metabolic syndrome related conditions, but there is much to be understood before such therapies could be introduced into the clinic.

Objectives Penetrating gunshot head injuries have a poor prognosis and require prompt care. Brain CT is a routine component of the standard evaluation of head wounds and suspected brain injury. We aimed to investigate the effect of brain CT findings on mortality in gunshot head injury patients who were admitted to our emergency department (ED) from the Syrian Civil War. Methods The study group comprised patients who were admitted to the ED with gunshot brain injury. Patients' GCS scores, prehospital intubations and brain CT findings were examined. Results 104 patients were included (92% male, mean age 25 years). Pneumocephalus, midline shift, penetrating head injury, patients with GCS scores ≤6 and patients who had to be intubated in the prehospital period were associated with higher mortality (p<0.05). Discussion The results of this study demonstrated that pneumocephalus, midline shift, a penetrating head injury, GCS scores ≤6 and prehospital intubation are associated with high mortality, whereas patients with temporal bone fracture, perforating or single cerebral lobe head injury had a higher survival rates. The temporal bone has a relatively thin and smooth shape compared with the other skull bones so a bullet is less fragmented when it has penetrated the temporal bone, which could be a reason for the reduced cavitation effect. In perforating head injury, the bullet makes a second hole and so will have deposited less energy than a retained bullet with a consequent reduction in intracranial injury and mortality. Further studies are required to reach definitive conclusions.

Introduction: Community-acquired pneumonia (CAP) is a frequent cause of hospitalization and a leading cause of mortality worldwide. Early diagnosis and the initiation of appropriate antibiotic therapy are essential to reduce pneumonia-related morbidity and mortality. CRP is a well-established biomarker in many clinical settings, but has been traditionally considered not specific enough to be a useful guide in the diagnostic process of pneumonia. There is still a need for more specific and practicalmarkers in CAP for diagnosis. The aim of this study was to investigate the diagnostic value of ischemia-modified albumin (IMA) levels in the diagnosis of CAP in the Emergency Department.Methods: The study included 81 patients admitted with CAP and 81 control patients. Initial hour levels of IMA and CRP were measured. The IMA mean levels were compared between the study and control group. Correlation analyses were performed to investigate the association of serum IMA levels with CRP.Results: Mean levels of IMA were 0.532 +/- 0.117 IU/ml in the study group and 0.345 +/- 0.082 IU/ml in the control group. IMA levels were significantly higher in the study group compared to the control group. The IMA level of 0.442 IU/ml had sensitivity of 75.3% and specificity of 91.3% and was positively correlated with CRP levels (r = 0.506; p < 0.05).Conclusion: Blood IMA levels significantly increase in adult patients presenting with CAP. IMA may be considered as a novel biomarker in the diagnosis of CAP. (C) 2017 Elsevier Inc. All rights reserved.

Arterial ischemic stroke (AIS) in adults is considered a serious health threat and requires urgent medical treatment. Prompt diagnosis allows the therapeutic option of thrombolysis within the time window of 3 to 6 hours after first symptoms. Alternatively, early anti-platelet therapy is effective in improving the outcome after stroke. The incidence of pediatric AIS range from 2 to 5 per 100 000 children/year. Pediatric AIS has severity and long-term outcomes similar to those in young adults. Two-thirds of children sustaining AIS have neurological deficits that may result in life-long disability, thus critically impacting their potential development. On the other hand 10%-30% of the causes of acute strokes are of unknown reasons, therefore careful structural, metabolic and genetic risk factors, requiring more specific treatment, should also be considered in any cases of stroke in children. The diagnosis and treatment should be conducted on the basis of a multidisciplinary approach, including pediatric cardiology, hematology, neurology, neurosurgery and neuroradiology.

Preparing to manage weapons of mass destruction events challenges emergency services systems neighboring Syria every day. Understanding injury from explosives is essential for all providers of emergency care in both civilian and military settings. In this case, the authors present a 22-year-old man who was admitted to the emergency department with displaced skull fracture, epidural hemorrhage and cerebral contusion due to barrel bomb tertiary blast effect. A 22-year-old man who complained of pain in the right temporal head region after barrel bomb explosion was admitted in the emergency department. The patient could not remember the explosion and found himself on the ground. In his medical history, there was not a record of any diseases, operations or traumas. Examination of the head revealed scalp hematoma and slump in the skull on the right temporal region. Patients computed tomography (CT) scan showed a displaced skull fracture, epidural hematoma and cerebral contusion.

Direct Primary Care (DPC), where patients pay a fee to a primary care provider to obtain access to services, is a delivery model that has received notable attention and enthusiasm from some providers. Proponents of DPC believe that the model increases accessibility, reduces overhead, and ultimately improves care for patients; however, there is little evidence in the peer-reviewed literature to support these claims. The objective of this analysis was to apply Starfield9s adaptation of Donabedian9s Structure-Process-Outcome conceptual model to evaluate primary care to formally display the links between potential changes in clinical structure and processes from DPC adoption. Based on existing literature on the constructs in Starfield9s model, expectations of DPC9s impact at the patient, clinic, and system levels were defined. DPC uses changes to financing and the population eligible to trigger potential gains in continuity and accessibility to subsequently improve care processes. There is evidence to support DPC as a theoretically sound approach to improve attributes of primary care, such as first contact care and longitudinality at the clinic level for participating patients. At the health system level, DPC has low-construct validity that would suggest a positive impact on the potentially eligible population9s health due to membership fees that exclude patients who are more likely to be vulnerable and complex than patients who are willing and able to stay in the practice. Descriptive and comparative research of included and excluded patients is needed to inform providers, patients, and policy makers of the DPC9s ability to attain the attributes of primary care and ultimately achieve better outcomes over alternative primary care delivery and financing models. Meanwhile, theoretic application informed by years of research on primary care provide insight as to what changes to expect and to monitor as practices consider DPC adoption.

Heat stroke is the most complicated and dangerous amongst heat injuries that can lead to irreversible injury and even death with itself or with creating predisposibility to different diseases. The following case report depicts a patient who presented primarily with impairment of consciousness after walking 45 km in the summer heat to cross the Syria-Turkey border and later syncope. This case report aims to highlight the possibility of higher co-incidence with heat stroke and stroke.

In emergency department, physicians can diagnose pulseless electrical activity, asystole, pericardial effusions, ischemic heart disease, wall motion abnormalities, valvular cardiac disease volume status or global cardiac function evaluating with electrocardiographic findings or using bedside cardiac ultrasonography. But these two methods are not always sufficient to explain the underlying another pathologies such as pancreatitis and acute cholecystitis which can mimick acute cardiac events. Patients who are followed up with a preliminary diagnosis of acute coronary syndrome in the emergency department, might have underlying biliary or pancreatic pathologies, or even more, these might be the sole reason of the clinical picture. So bedside abdomen ultrasonography and liver enzymes may be requested in all patients with suspected cardiac pathology with a normal cardiac ultrasonography when a patient presented with acute chest or abdominal pain. Physicians must be aware for coexisting pathophysiologies and take into account the differential diagnosis of all life-threatening causes such as cardiac ischemia or acute abdominal situations. So the diagnostic tests for gallbladder pathology could be added to cardiac ultrasonography.

Penetrating injuries due to the presence of suspected foreign bodies are a common problem for the emergency department (ED). Foreign bodies should be extracted from wounds as soon as possible during the primary wound management stage. Foreign body injuries may be located in superficial and deep tissue. In addition to determining the correct location, correct diagnosis may be quite difficult. Superficial foreign bodies are easily removed, but the management of those in deep tissue can be extremely difficult and therefore requires surgical removal.

Trauma-related embolic events in pulmonary vascular bed are generally due to fat or thrombus embolism. In this report, we present a patient who had severe hypoxia and tachycardia at postoperative period after surgery of an open tibia fracture. Because of the clinical and electrocardiographic findings, we calculated patients Wells score as “pulmonary embolism likely” (N4 points, 28%-52% pulmonary embolism risk), and we performed chest contrast computed tomography. There was no abnormal finding in contrast to chest contrast computed tomography that could suggest fat or thrombus embolism. Because of persistent hypoxemia, we performed transthoracic echocardiographic examination to exclude an intracardiac shunt. In transthoracic echocardiographic examination, we found an atrial septal defect with intermittent right-to-left shunt due to high central venous pressure.

Yabanci cisim yutulmasi pediatrik yas grubunda eriskin yas grubuna gore daha sik gorulmektedir. Yutulan yabanci cisim tibbi komplikasyonlara neden olabilmektedir. Tedavi yaklasimlari cesitlilik gosterse de yabanci cismin cogunlukla gastrointestinal sistem araciligi kendiliginden atilmaktadir. Yabanci cisim yutan hastaya uygulanan tedavi yaklasimi hastada gorulen klinik tabloya gore degiskenlik gostermektedir. Bu olgu sunumunda uc adet toplu igne yutan hastaya uygulanan uc farkli tedavi yaklasimi bildirildi.

Özet Yabancı cisim yutulması pediatrik yaş grubunda erişkin yaş grubuna göre daha sık görülmektedir. Yutulan yabancı cisim tıbbi komplikasyonlara neden olabilmektedir. Tedavi yaklaşımları çeşitlilik gösterse de yabancı cismin çoğunlukla gastrointestinal sistem aracılığı kendiliğinden atılmaktadır. Yabancı cisim yutan hastaya uygulanan tedavi yaklaşımı hastada görülen klinik tabloya göre değişkenlik göstermektedir. Bu olgu sunumunda üç adet toplu iğne yutan hastaya uygulanan üç farklı tedavi yaklaşımı bildirildi.